Superior Quality, Distribution, and Service Engineered to Your Specifications.

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Customer Credit Application

 

GENERAL INFORMATION

*All Fields are Required

Credit Line Requested:             

Company Name:              Federal ID #:             
Street Address:              City/State/Zip:             
Mailing Address:              City/State/Zip:
Ship-to Address:              City/State/Zip:
Accounts Payable Contact:              A/P Phone #:             
Purchasing Contact:  Purchasing Phone #:             
BANK INFORMATION  
Bank Name:              Account #: 
Address:  City/State/Zip: 
Contact Name:   Phone #: 
CREDIT REFERENCES  
Company:  Phone #:   Fax #: 
Address: Contact:  
   
Company:   Phone #:   Fax #:  
Address:   Contact:  
   
Company:  Phone #:  Fax #:  
Address:   Contact:  

I hereby certify that the above information is true and correct.  I further agree that Bourbon Plastics may investigate our credit record for the purpose of establishing a business account.  I also understand that all invoices must be paid within 30 days or we will be subject to a service charge of 1.5% per month on past due invoices.ices.

Your Name:  Title: Date: 
Email Address:             

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